| NPI | 1699874420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00001851) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: WA OD00001851) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2013-01-03 |